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December 2016 Texas Medicaid Provider Procedures Manual

Medicaid Managed Care Handbook : 10 PCCM and Managed Care Claims Processed by TMHP Before March 1, 2012 : 10.2 PCCM Cost and Reporting : 10.2.1 PCCM Outpatient Services Cost Reporting

10.2.1
PCCM Outpatient Services are subject to cost report settlements. PCCM outpatient services providers are not required to submit any additional forms or reports, because HHSC has required providers to submit the necessary PCCM supplemental worksheets along with the CMS form number CMS-2552-96, “Cost Report for Electronic Filing of Hospitals,” for hospital cost reports that end on or after October 1, 2007. The PCCM supplemental worksheets include the Inpatient PCCM D-4 worksheet and the Outpatient PCCM D, Part V worksheet.
The interim cost report settlement process will be completed within six months of the date on which the TMHP Medicaid Audit Department receives the workable cost report. The cost settlement is determined by comparing the total Medicaid-allowable costs to the provider’s interim payments for PCCM outpatient hospital services that were delivered during the reporting period. HHSC will then issue a notice of settlement that specifies the amount due to or from the PCCM outpatient hospital.

Texas Medicaid & Healthcare Partnership
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